Ten weeks before Corizon Health abruptly canceled its $1.2 billion contract to treat Florida prison inmates, yet another account of lethal care by the Tennessee-based company landed on Florida Department of Corrections Secretary Julie Jones’ desk.
At Florida Women’s Reception Center in Ocala, inspectors found, a woman with diabetes went almost three months without insulin. One inmate with a golf ball-sized lump behind her ear was referred for an MRI and a surgical consult. She got neither.
A doctor’s “urgent” request for thyroid surgery for an inmate with a history of thyroid cancer languished for eight months. Another inmate with a brain aneurysm waited two months before seeing a specialist.
Psychiatric care was similarly disturbing. Inmates at risk of self-harm can be held only in certain types of isolation cells for 72 hours. But one woman spent four days in a cell, another spent five days and yet another spent six.
In four cases cited by inspectors, it appeared mentally disturbed inmates were inexplicably taken off their prescribed psychiatric medication.
The inspection team requested emergency action by DOC for what they believed could be life-threatening lapses in care.
DOC responded within 72 hours, insisting on more staff, more training, more state oversight, more specialist appointments.
The problems mirrored findings of a 2014 Palm Beach Post investigation that documented soaring fatalities and substandard care after Corizon and Wexford Health Source were awarded control of the state medical system. While inmates are not entitled to excellent care, the U.S. Supreme Court has ruled that they are entitled to adequate care.
Jones announced in February that DOC would rebid its contracts. Corizon’s decision Monday to pull out in six months forces the state to find a health care provider for about 150 prisons and other facilities long before a new contractor can be selected, perhaps not until mid-2017.
“We have tried to address the department’s concerns but have found the terms of the current contract too constraining,” Corizon Health CEO Karey Witty said in a prepared statement. “At this point, we believe the best way to move forward is to focus our efforts on a successful transition to a new provider.”
Death rate peaked
Partly because Corizon cares for the vast majority of state inmates, it has been at the center of criticism over care in the newly privatized health system, which quickly delivered lethal consequences.
Prison inmate mortality rates hit a 10-year high within 100 days of privatization, The Post found. Referrals to hospitals and specialists plummeted.
Information on inmate deaths wasn’t regularly turned over to the state, and medical exams showing whether inmates were injured by guards sometimes were missing.
Corizon also was involved in some of the most dramatic incidences of medical neglect uncovered by The Post. Three prisoners dying of cancer were misdiagnosed by Corizon staff, even after, in one case, bulging tumors visibly riddled the inmate’s body. All were given Tylenol and ibuprofen for their spreading cancers. Two of the inmates died and a third was given early release for health reasons.
Corizon pledged reform. But problems continued. In February, just 18 months after for-profit firms took full control of prison health care and four months after The Post investigation, Jones scrapped the five-year contracts.
Corizon’s contract requires six-month notice, meaning it will provide care through May 31.
At the Florida Women’s Center, Corizon is responsible for almost 1,000 inmates, many with histories of serious illness.
Corizon spokeswoman Martha Harbin described it as “one of the more challenging locations in which to provide care.” It is the central point of entry for all women entering the state prison system, she said. And its population more than doubled just as Corizon assumed responsibility for health and psychiatric care.
In a routine September inspection, the Correctional Medical Authority faulted the company for a myriad of shortcomings. The state watchdog panel, which is independent of DOC, reported inadequate treatment of chronic and serious illnesses, failures to get inmates to off-site surgeons and specialists, and critically, missing or incomplete medical records.
Such records are not just paperwork. For instance, inspectors found medical files where there was no record of an inmate’s vital signs, such as pulse and blood pressure. Some medical files didn’t include a diagnosis.
Records of whether medicines were given didn’t exist, raising the question of whether they were administered. In fact, large numbers of prescriptions had not been filled because the prescription wasn’t correctly filled out. Inspectors found a gap of a month or more in paperwork that would have proved psychiatric medicine was being dispensed.
Further, records that would have confirmed medical staff saw four patients on weekends and holidays were missing, as did records to show that medical staffers checked in on certain ill inmates.
In two instances, records weren’t just missing, they were suspect. A patient’s vital signs in one file were identical for every day for more than a month. In another, vital signs taken twice weekly for several weeks never changed — except to record a massive, and unexplained change in weight from 143 to 250 pounds.
Inmates could wait weeks, or even months, before abnormal test results were looked at by medical staff — and even longer for treatment.
An inmate with lesions in her brain and a history of cancers had an abnormal cancer screen in May, did not get diagnostic testing until August and was not referred to an outside cancer specialist until September. All the while, she was telling medical staff of symptoms indicating a spreading cancer.
An inmate with a large mass in her abdomen was prescribed multiple tests by a surgeon in January, but delays in getting prison medical staff to review the test results meant she was not operated on for another five months.
“We were aware of challenges at the site prior to the Correctional Medical Authority audit and were taking steps, such as adding staff, to resolve them,” Corizon spokeswoman Harbin said.
Post-audit, she said, 78 Corizon employees were brought to the prison to discuss medical needs with all 895 inmates. Response from DOC has been positive, said Harbin: “We look forward to CMA’s re-inspection.”
Despite failures of care, DOC is still embracing privatization, making good on a high-profile campaign promise by Gov. Rick Scott to privatize prison medical care.
The sheer size of Florida’s prison population makes that a challenge.
Not only does Florida have the third-largest state prison system in the country, it also houses the fastest-growing number of elderly inmates of any state prison system — a population of inmates in need of increasingly complex, and expensive, medical care.
“We are very aware of scale,” said DOC spokesman McKinley Lewis. Part of contracting with new firms, he said, will be “making sure they are aware just how big this project is.”
DOC is considering splitting up new contracts into smaller, more manageable units. For instance, one company might handle dental care and another might handle medical care.
Corizon still could be one of those companies. Lewis said the decision to cancel the current contract does not disqualify them from rebidding.
The company hasn’t decided yet whether it will do so when invitations to negotiate are issued by DOC, probably later this month.
Both Corizon and Jones say for now, the emphasis will be on maintaining care as the company transfers responsibility for health care to DOC. “Above all,” Witty said, “Corizon Health will continue to provide high quality care to Florida’s inmates.”
Fatal cancers of three inmates were misdiagnosed by Corizon and treated with over-the-counter painkillers:
Donna Pickelsimer, 56. Placed in solitary confinement after telling nurses from Corizon that she was in so much pain she wanted to cut off her arm, Pickelsimer’s visible, spreading tumors were treated with Tylenol, ibuprofen and warm compresses. She died in June 2014.
Anthony Carvajal, 44. In work-release, Carvajal’s spine fractured in several places, the result of a spreading cancer. Corizon medical staff diagnosed a pulled muscle and given ibuprofen. He was given an early release granted to certain dying prisoners.
Tammie White, 45. White died in January 2015, shortly after prison medical staff from Corizon treated her using Tylenol with codeine and ibuprofen. By then, untreated cancer had spread through her lungs, bones and brain.
What The Post reported
In Dying for Care, an award-winning investigation published in September and October 2014, The Post detailed rising death tolls and incidents of neglect in state prisons after private companies took over the health care of inmates. Read the stories at myPalmBeachPost.com.